Medicare Criteria is PUBLISHED!

It’s finally here!!! Type 1 and Type 2 diabetes patients covered by Medicare who are on intensive insulin therapy may now get reimbursed for their Dexcom G5 CGM!

Dexcom’s G5 Mobile system is the only CGM classified as “therapeutic.” A therapeutic CGM is used to inform treatment decisions. Most CGMs are FDA-approved as adjunctive devices, meaning the information they provide is to be used alongside data from other devices, such as blood glucose monitors.

The CMS criteria are that the patient must

have diabetes

use a home blood glucose monitor to test for glucose levels frequently

be treated with multiple daily injections of insulin or with an insulin pump, and

need to frequently adjust his or her insulin therapy based on data from a therapeutic CGM

“This is a new era and a huge win for people with diabetes on Medicare who can benefit from therapeutic CGM,” said Dexcom CEO Kevin Sayer in a statement. “This decision supports the emerging consensus that CGM is the standard of care for any patient on intensive insulin therapy, regardless of age.”

It is great cause for celebration. Let’s hope that the new sensor from Medtronic will also qualify. It obviously is used for treatment decisions since it effectively will run the pump. It’s good to be alive.